Characteristics and Outcomes of Discharges Against Medical Advice Among Hospitalized Patients.

MedLine Citation:

PMID:
23461391
Owner:
NLM
Status:
Publisher

Abstract/OtherAbstract:

The objective of this long-term and hospital-wide study is to examine characteristics of patients who discharge against medical advice (DAMA), their rates of readmission and mortality after self-discharge. Administrative data of admissions to Flinders Medical Centre (FMC) between July 2002 and June 2011 was used to compare readmissions and mortality among patients who DAMA with those did not. The outcomes were adjusted for age, gender, emergency admission status, comorbidity, mental health diagnoses and alcohol and substance abuse. In the study period, 1,562 episodes (1.3%) of 121,986 admissions to FMC were DAMA. Compared with those who didn't leave against medical advice, these patients were younger, more often male, more likely of indigenous ethnicity, and had less physical comorbidity, but greater mental health comorbidity. Half of the DAMA group stayed less than 3 days. In multivariate analysis, the relative risk for 7-day, 28-day and 1-year readmission in the DAMA group was 2.36 (95% CI: 1.99-2.81; p <0.001), 1.66 (95% CI: 1.44-1.92; p <0.001), 1.31 (95% CI: 1.19-1.45; p <0.001), respectively, compared to standard discharges. Furthermore, DAMA was associated with 2-fold (p = 0.02), 1.4-fold (P = 0.025) and 1.2-fold (p=0.049) increase in 28-day, 1-year and up to 9-year mortality, respectively, compared to non-DAMA. Patients who self-discharged against medical advice carry a significant risk of readmission and mortality. Patients with characteristics of "at risk of DAMA" should have greater attention paid to their care before and especially after any premature discharge.